Provider Demographics
NPI:1982664702
Name:GARRETT, SAMUEL D (OD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:D
Last Name:GARRETT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4020
Mailing Address - Country:US
Mailing Address - Phone:864-232-2779
Mailing Address - Fax:864-232-2751
Practice Address - Street 1:210 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4020
Practice Address - Country:US
Practice Address - Phone:864-232-2779
Practice Address - Fax:864-232-2751
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCL3462OtherRAIL ROAD MEDICARE
SC0643360001OtherDMEPOS
SC410023165OtherRAIL ROAD MEDICARE
SC4069Medicare PIN
SC410023165OtherRAIL ROAD MEDICARE
SCT24184Medicare UPIN